Physical Therapy Billing G Codes Made Easy!

Physical Therapy Billing G Codes may seem to be a big burden for therapy clinics but it doesn’t have to be.

Medicare Will Require G-Codes and C-Modifiers be Included on the Claim

All physical therapy billing, as well as occupational therapy and speech therapy billing, will have to include functional reporting G codes and C modifiers on the claims or they will get denied beginning July 1, 2013. Don’t worry, the new requirements are not that difficult to implement. And these efforts are for the purpose of moving away from the faulty Medicare “Cap” system currently in place. This article will explain how to make physical therapy billing G codes easy!

Where do these “G Codes” (and C modifiers) Go on the HCFA Form?

It might be best to start by showing you exactly where these new G codes will go on the claim form. See pic below.

Where the codes go

Highlights (refer to the pic above of a physical therapy billing g codes on a claim):

The G codes go in the same column as your CPT codes but do not carry with it any charges.

The C modifier goes into one of the four “modifiers” column.

Remember to always add the “GP” modifier even to these functional non-payable codes.

I will explain how you determine which G code or C modifier to use in a moment. I wanted to first have you see where these codes actually go.

Here are the steps to making this whole process easy:

1. Know WHEN to Report G-Codes

– You should always report at the outset of therapy (on date of initial therapy service).

Self-Care: Washing Oneself, Toileting, Dressing, Eating & Drinking

G8988 Self-care functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting.

G8989 Self-care functional limitation, discharge status at discharge from therapy or to end reporting.

Other PT/OT Primary Functional Limitation

G8990 Other physical or occupational primary functional limitation, current status at therapy episode outset and at reporting intervals.

G8991 Other physical or occupational primary functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting.

G8992 Other physical or occupational primary functional limitation, discharge status at discharge from therapy or to end reporting.

Other PT/OT Subsequent Functional Limitation

G8993 Other physical or occupational subsequent functional limitation, current status at therapy episode outset and at reporting intervals.

G8994 Other physical or occupational subsequent functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting.

G8995 Other physical or occupational subsequent functional limitation, discharge status at discharge from therapy or to end reporting.

3. Choose Your C-Modifier

The C modifier indicates the severity of the functional limitation. Medicare does expect to see progress in their primary functional limitation after treatment is initiated.

Severity of Limitation

You are allowed and suggested to use assessment tools and/or objective measures in determining the severity of the functional limitation. Multiple tools may be used. Of course, the therapists judgement in combination with the data should also be used.

Important: Make sure to document the G codes in the medical record along with your rationale on how you determined the severity.

Sample of Reporting

Here’s an example of how you would report on a patient that had impaired walking or moving.

That’s pretty much the basic essentials to the whole requirement. Don’t worry. In time it will become second nature.

***BEWARE:***

More and more third party payers are adopting Medicare policies and are putting into the contracts you have that they “Follow Medicare Policies”. You must do the functional reporting with them as well or later they will come back and use it as an excuse to take money back from you. This is real. We have tools to make it easy to do functional reporting on every patient with little work (such as the Daily Flow Sheet and Resource Page). Contact me for more information. ***

If you want to learn more on this subject, we have a comprehensive video tutorial available for you. The cost is nominal and proceeds go to helping therapists undergoing scrutiny. This video can be used to easily train your entire staff! Email me at support[at]indefree.com.

Physical therapy billing is evolving and changing. But it doesn’t have to be difficult. You just have to learn and adjust.

“It’s NOT the strongest or most intelligent that will survive and grow, but the one most adaptable to change.” -JamesPT

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About James Ko

I believe...
"It's not the strongest practices that survive and grow, nor the most intelligent, but the ones most adaptable to change."

I'm a physical therapist, private practice owner, and founder of IndeFree Association. I like reading James Patterson, Nicholas Sparks, enjoy golfing and playing guitar. I love playing with Mac and Cozy! For over 12 years, I've helped thousands of practices grow and succeed. This is my dedication.